Achalasia

Overview

Achalasia is a rare esophageal motility disorder that makes it difficult for food and liquid to pass into your stomach.

Achalasia occurs when the nerve cells in the esophagus cause the muscles in the esophagus and in the lower esophageal sphincter (LES) to not work properly. The muscles in the esophagus do not contract normally, so food that is swallowed does not move through the esophagus and into the stomach the way it should. Normally the LES relaxes when we swallow to allow food into the stomach. With achalasia, the LES muscle continues to squeeze, creating a barrier that prevents food and liquids from passing into the stomach. Because the LES contracts abnormally, the esophagus dilates and large volumes of food and saliva can accumulate over time.

People with this disorder have an increased risk of esophageal cancer.

Symptoms of Achalasia

Dysphagia (difficulty swallowing)

Heartburn

Feeling of food stuck in your throat or chest

Weight loss

Coughing, especially when lying down

Chest pain

Aspiration- food, liquid and saliva which is retained in the esophagus can be inhaled into the lungs

Achalasia may be difficult to diagnose because its symptoms are similar to other digestive conditions such as acid reflux, also known as gastroesophageal reflux disease (GERD). There are tests that can diagnose achalasia.

Tests to Diagnose Achalasia

Esophageal manometry

Barium esophagram

Upper endoscopy

While there is no cure for achalasia, it can be managed with treatment.

Treatments for Achalasia

Medications such as calcium channel blockers and nitrates that can help dilate the narrowed part of the esophagus so that food can pass through properly

Dilation (stretching)

Laparoscopic Heller myotomy: surgery to the lower esophageal sphincter. The surgeon may also perform a fundoplication during this surgery to reinforce the LES and prevent reflux of food and liquid into the esophagus.

Botox injections: this muscle relaxant can be injected into the LES with an endoscope. This option is mainly used for older patients who are not good candidates for surgery.